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Interview With Representative And "I Swear Politics Is Messier Than My Minivan" Author Katie Porter (D-CA); Interview With Former French Ambassador To The U.S. Philippe Etienne; Interview With International Institute For Strategic Studies Senior Adviser For Europe Francois Heisbourg; Interview With "The People's Hospital" Author Ricardo Nuila. Aired 1-2p ET
Aired April 11, 2023 - 13:00:00 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
CHRISTIANE AMANPOUR, CNN CHIEF INTERNATIONAL ANCHOR: hello everyone and welcome to AMANPOUR. Here's what's coming up.
(BEGIN VIDEO CLIP)
REP. KATIE PORTER (D-CA) AND AUTHOR, "I SWEAR POLITICS IS MESSIER THAN MY MINIVAN": What are we fighting for? We're failing for liberty. We're
failing for freedom. We're fighting for justice.
(END VIDEO CLIP)
AMANPOUR: As President Biden visits Northern Ireland to celebrate the Peace Process, we dig in to the existential challenges facing his party at
home, from guns, to abortion, rights, to the judicial system. I speak to Democratic Congresswoman Katie Porter about all of this, and her run for
Senate in 2024.
Then, United States and China conduct military exercises in Asia. But has the French president, Emmanuel Macron, driven a wedge between the
Transatlantic allies by saying Europe should stay out of the Taiwan debate? We'll have the latest.
Also ahead --
(END VIDEO CLIP)
RICARDO NUILA, AUTHOR, "THE PEOPLE'S HOSPITAL": This health care crisis manifest in so many ways that we don't think about, that's hidden from us.
(END VIDEO CLIP)
AMANPOUR: What the American Health Care system could learn from one Texas hospital. Author and doctor Ricardo Nuila talks to Hari Sreenivasan about
his new book on this issue.
Welcome to the program, everyone. I'm Christiane Amanpour in London.
President Joe Biden flies to Belfast, Northern Ireland tonight for a major celebration, 25 years since the historic Good Friday Peace Accords and
America's vital role in making that happen. Biden's four-day visit to the island comes as he signals ever louder his intention to definitely run
again for president in 2024. Just as hot button election issues around guns, race and a woman's right to choose ask vital questions about the
state of U.S. democracy.
A Trump appointed judge in Texas wants a nationwide ban on an abortion pill that's been approved for use by the FDA for more than 20 years now. While
in Tennessee, Republican state legislators expelled two black Democratic members who took part in an anti-gun protest, one of them, Justin Jones has
now been reinstated.
Democratic Congresswoman Katie Porter has become a star in Washington by holding what she calls this abusive power accountable. She's known far and
wide for her tough questions and trademark white board. She's now running for Senate in California, and she's out with a new book for the campaign
called, "I Swear: Politics is Messier Than My Minivan."
And I've been speaking to her about the challenges that rock America right now, and also about how to maintain America's role as a global beacon of
Congresswoman Katie Porter, welcome to the program.
REP. KATIE PORTER (D-CA) AND AUTHOR, "I SWEAR POLITICS IS MESSIER THAN MY MINIVAN": Thank you for having me.
AMANPOUR: I want to start by asking you about an issue that has -- you know, has Transatlantic wings and has landed here as well, obviously, very
important to American women, and that is this Texas judge who has decided that the drug, Mifepristone, is not going to be allowed to anybody in the
United States, the abortion pill. The Justice Department is appealing that.
How does that happen? From this perspective, how does one judge in Texas, how is he able to make a ruling for the entire United States?
PORTER: Well, what the judge ruled is that the FDA, our Food and Drug Administration, acted unlawfully, in this judge's opinion, with regard to
the authorization and approval of Mifepristone. And because it is a federal case, it has federal authority. We do expect it's unlawful in the lay (ph)
and it's a federal court. So, it makes it unlawful everywhere. There will be -- obviously, be an appeal of this decision, and I fully expect it to be
It's -- the basic argument here is that the FDA did something wrong in its scientific work. And of course, it's very unusual to have a judge be put in
the position of sort of critiquing and criticizing the scientific and regulatory process.
AMANPOUR: So, you say it is going to be appealed and as we've seen. But just before we get to the legalities, what about the impact on women? What
will this mean for the women who are already finding their access to surgical abortions restricted, some at great risk to their own lives,
including recently in Florida? What will it mean if even this pill is banned all over the U.S.?
PORTER: Well, we're definitely hearing our state and local officials in locations like California, where abortion remain safe and legal, talk about
that. Make people aware that there are still options. Governor Newsome in California recently announced that we have about 2 million pills on hand.
And so, I think the hope is that this won't have any practical effects that the decision will appeal and be reversed before that.
But it's certainly discourages people. It makes them fearful. There's a lot of misinformation out there. We saw the exact same, by the way, set of
effects after our United States Supreme Court decided the Dobbs decision limiting the -- taking away the constitutional right to an abortion,
reversing Roe. A lot of fear, lots of misinformation. And that is part of the intentional political strategy of those who are trying to substitute
their judgment for the judgment of doctors and patients and their families about when and if to have a child.
AMANPOUR: Can I then ask you about this as a political issue and as an electoral issue, we saw that women were motivated by this, you know,
restriction of their rights, do you think that this will remotivate them, keep them motivated for the 2024 election? You're running for Senate, but
obviously, there's a presidential election as well.
PORTER: This is a huge issue for -- not just women, but for all Americans. Because fundamentally, the decision about having an abortion is a freedom
issue. It's about each person being able to make their own decision rather than the U.S. government and a few extremist politicians making it for
them. And that is really then core to democracy.
What are we fighting for? We're fighting for liberty. We're fighting for freedom. We're fighting for justice. And this is an issue that touches on
those very values. So, I absolutely think it will drive people to be politically active, to remain politically active and to come out into the
And I think that the Democrats who have taken a unified and strong stance on protecting the right for each person to make their own decision about
abortion are going to be the winning party in 2024 on this issue, as well as on the issue of gun violence, where we're also seeing Americans, again,
pushing and pushing Congress to pass laws, their government leaders to act in accordance with their wishes. And that's what they understand democracy
to be about.
AMANPOUR: Let me ask you about the threats to American democracy, you've just -- you know, obviously, you know, gun violence and the threat to
women's rights, all of these, you know, form also a threat to individual life, liberty and democracy. But here, just some headlines, right, that I
want to, you know, throw by you to see your reaction.
This week, the expulsion of the two African American legislators from the Tennessee House by the Republican super majority. Now, one of them, one of
the Justins is being reinstated. But again, that combined with reports that a Supreme Court judge, Clarence Thomas, has accepted undisclosed luxury
trips from a conservative billionaire for more than 20 years. Obviously, we got Donald Trump's indictment for falsifying business records. I know
that's throwing a lot together, but do you see any link?
PORTER: I mean it, we've seen consistent efforts to undermine the core institutions of American government. So, yes, I think these are all part of
an overarching strategy by those who want to weaken government for their own benefit, and those are largely corporate special interests, extremist
politicians, the billionaires who have too much influence in our politics. And so, I think they are all connected and that they are all kind of
attacking people's fundamental confidence in government institutions.
We assume that our court is free of corruption. That's something we take a lot of pride in the United States, historically. Something we compare
ourselves favorably to with regard to other countries. We assume in the United States that if you're duly elected, you'll be able to serve. That's
an attack on the legislature, which is what you've seen in a legislative branch of government, which is what we've seen in Tennessee.
So, yes, I think they're all designed to weaken people's trust in government. And I think that has the effect of allowing those with power to
exert more control over government, weakening the ability of people to have their voices heard.
AMANPOUR: So, you most certainly have become very, very well known since your election to the house. And it was your first run for politics as
somebody who holds the powerful accountable, the famous white board. You're the co-founder of the End Corruption Caucus, talking about the
billionaires, as we just were.
I want to just play a little clip from a while ago when you confronted or had an exchange with of pharma executive. This is Robert Bradway of the
Amgen Corporation. He's the CEO.
(BEGIN VIDEO CLIP)
PORTER: Do you not know why you're getting hundreds of millions of dollars, tens of millions of dollars a year? What is the justification? I'd
like to show the American people.
ROBERT BRADWAY, CEO, AMGEN: You know, our compensation is consistent with competitive positions at other companies --
PORTER: Mr. Bradway, reclaiming my time. The other guy gets paid too much too isn't a justification.
(END VIDEO CLIP)
AMANPOUR: I don't know how that all turned out, but I'm sure that my team must tremble now when you throw out that white board and hold them publicly
accountable. You are running for Senate. And you have said in your book, I don't do Congress the way others do. So, explain that and why you are
running for this position that's being vacated by the longstanding senator Democrat, Dianne Feinstein.
PORTER: Well, in my time in Congress, what I've shown is that the American people are interested in what their leaders are doing, but they want those
leaders to show them that. They -- part of the reason I use the white board is to make it easier for people to understand that I am in fact asking the
questions on their mind, why are CEO's being paid hundreds of millions of dollars when they're failing to invest in the company and the workers and
the small businesses and the supply chain?
And so, I think what I showed a willingness to do is to stand up to power. And I think that's remarkably rare in Washington. That's something I talk
about in the book, the power of corporate donors, the power of lobbyists. I'm one of 11 members of the House of Representatives, which has 435
members, one of 11 who doesn't take contributions from federal lobbyists. And I think it shows what I am willing to go toe to toe with powerful
people and ask them the questions that while they may be unusual in Washington, I think are the exact questions that are on the minds of most
Americans most of the time.
AMANPOUR: So -- or maybe as a way to get yourself wider -- I don't know whether you can get wider attention, but you've written this incredible
memoir in which you call, "I swear" Politics is Messier Than My Minivan." Let's talk about that. I mean, the funny title. But how messy is your
minivan but also politics as you found it?
PORTER: Well, my minivan is pretty messy, but I would say politics is even worse. I'm a Californian. So, there's always a lot of beach sand in my
minivan, discarded cups, paperwork from the kids, homework that's been abandoned. But I think politics is even messier. And I think some of that
is inherent in our democracy and I think it is sort of baked in to the very idea of representative government, of having a bicameral legislature with
the house and the Senate and the checks and balances that we have, for example, between our legislative branch and our executive branch.
But I think the reason I wrote the book is to reveal to people some of that math. I think it's OK to show the American people what democracy is really
like, that's it's not that easy, that it is hard, that there are corrupting influences.
What you often hear from people in politics is this condescending attitude that you just -- you, the regular voter, just couldn't understand how
Washington works. That's nonsense. And the American people can and must understand how Washington works and why a lot of times it doesn't work. And
that's really the goal in the book, is to be honest about that, to show them why it's so hard to get anything done, how Washington really works,
what is the role of special interest in corporate donors in Washington, and what can we do about it.
AMANPOUR: You know, to that point, you are famously a single mom. You had young children when you decided to run for Congress. I mean, they're still
young, obviously, but they've grown up, they call you Congress Mom, and you write very frankly in your book about being a single mother, about, you
know, experience, you know, sort of a threatening environment from your then-husband, when it became time, you know, that you wanted to get out of
And I just wanted -- that obviously is very similar to what so many women experience in the United States, working single mothers, you know, in some
cases, domestic abuse, having to be, you know, all things to people all the time. So, I guess do you find that really cements you as an elected
representative and what did your kids think about what you wrote about their father?
PORTER: The kids definitely were, I think, tough critics of the book. I think part of them feels like they just want their mom to be a mom. They
don't want their mom to also be, in this case, a Congress person. But I think a lot of kids feel that way about their mothers, you know, about
their parents, the competition between taking care of your family and taking care of your job. I think most of us feel that, who are working
And I think in the book, I'm really honest about that struggle. That difficulty doesn't go away when one's elected to Congress. In fact, it's
just harder. You know, as a job, it's not a 30-minute commute, it's a 3,000-mile commute. It's -- you know, my colleagues are challenging, to put
it generously, I think in some cases.
And so, it is a tough job. And I think that -- like all kids, my kids sometimes, you know, wish they could just have their mom be their mom. At
the same time, I think they feel proud of what I've been able to accomplish. And I think I certainly, as a mother, look at my children and I
see what they have learned, that they are very thoughtful and savvy citizens, that they're going to be amazing Americans, they're going to be
terrific voters when the time comes.
And so, there is sacrifice for them, but I also see the strength that they've gotten out of having their mom involved in politics.
AMANPOUR: Let me ask you about the next presidential election. President Biden is old but saying he pretty much confirmed to Al Roker, NBC weather,
that he would be running but hasn't made the announcement yet. You see the hullabaloo around Donald Trump with the indictment and the divisions within
the Republican Party what to do about this character.
What do you -- how do you foresee this next year of campaigning turning out and what do you think will be the challenges both for Biden, if he runs,
and for Trump, if he is the nominee?
PORTER: President Biden has -- is on a strong footing in this election because he's delivered for the American people. He's going to be able to
talk about the infrastructure bill and point to projects in almost every county, community, part of this country that the bipartisan infrastructure
project has funded. He's going to be able to talk about investing in American jobs with science and bringing back manufacturing here of
semiconductors to the Chips Act. He's going to be able to talk about addressing the climate crisis with his initiative and bringing down home
energy costs for people with the Inflation Reduction Act.
So, he's someone who has accomplished a tremendous amount as president and he's going to be able to run I think a very strong campaign on policy
because he's actually delivered things that improve Americans lives.
President Trump, on the other hand, I think is simply going to cast accusations. He's going to be divisive. He's going to continue to incite a
kind of brand of, I think, very damaging and extremist politics. And I frankly think Americans, even those who are more Republican or more
conservative, are tired of that.
I represent Orange County, California right now in the U.S. Congress, and it's a very split area, about even numbers of Democrats and Republicans.
And even folks who have voted for Donald Trump in the past I think are tired of him. I think they'd like to see a Republican Party return to doing
the serious work of American democracy, and that will never happen with Donald Trump as the nominee and certainly not as the president.
AMANPOUR: Interestingly, in your bio, I see that you interned for a Republican senator, Iowa, Charles Grassley. So, you obviously know what
it's like, presumably, to work across the line and across the aisle when it's possible. But what I want to ask you is about your competition during
your Senate campaign now. There are other high-profile, like you, Democratic Congress people, Adam Schiff and Barbara Lee, who also would
like to have this seat. What do you think sets you apart to win the seat of Dianne Feinstein?
PORTER: What I've shown is a willingness to rethink how we do politics. I've been willing to hold people to account. I've shown that congressional
hearings are not just opportunities for politicians to give speeches, but they are moments in which we can push for and get real answers and
meaningful solutions in people's lives.
For example, during COVID, in the early days of COVID, I questioned the CDC director and got him to commit, to make testing free for every American.
That only was a big public health victory, but it was also a tremendous victory for people's confidence in government.
So, as California's next senator, my goal would be able to continue to show people that our elected officials can and should work for us and that
they're willing to stand up to the CEO's, the special interests who have too much power in Washington to put our interest first.
AMANPOUR: Congresswoman Katie Porter, thank you so much indeed.
PORTER: Thank you.
AMANPOUR: So, next to the one issue that does seem to unify Democrats, like Katie Porter, and Republicans, and that is China. Tensions just keep
mounting between the United States and Beijing. The U.S. started joint military exercises with the Philippines today, just as China wraps up their
days of drills around Taiwan.
But Washington is deeply concerned now about French president, Emmanuel Marcon's, recent rapport with President Xi Jinping, and his declaration to
the political new side that Europe needs strategic autonomy and especially on the issue of Taiwan. He said, the worst thing would be to think that we
Europeans must become followers on this topic and take our cue from the U.S. agenda and a Chinese overreaction.
Joining me now on this is Philippe Etienne. He's the outgoing French ambassador to the United States. And Francois Heisbourg. He's a senior
advisor for Europe at the International Institute for Strategic Studies. Gentleman, welcome back to our program.
Is this a NATO brain dead moment? Is this something that people just can't get their heads around? Philippe Etienne, as a member of the president's,
you know, government, I suppose, a former member, what do you make of what he said about strategic autonomy and particularly on the issue of Taiwan?
PHILIPPE ETIENNE, FORMER FRENCH AMBASSADOR TO THE U.S.: Well, thank you, Christiane, for inviting me. I am now happy visiting professor at
Columbia's at SIPA at Columbia. And I am -- thank you for inviting me.
I don't think this statement by our president about strategic autonomy is really knew. It doesn't mean that we are equidistant between China and the
United States. It doesn't mean that we are not allies with United States.
I would say, on the contrary, that it means that there is a confirmation by our president that we want to build our strategic autonomy, our sovereignty
to be better allies, to be more efficient allies and to build up our defense, to be more resilient economically, to build up our energy
independence after the Russian invasion of Ukraine. And finally, I think it is in the best interest of such an alliance to have European side, which is
And by the way, France was a first country in the European Union because where our Pacific country, also, we have our territories in the Indo-
Pacific, Indian Ocean and Pacific Ocean, who had its own Indo-Pacific strategy. We have military assets. We have 2 million people in the region.
So, we are very much interested in keeping Indo-Pacific as an open region and where there is a respect of international law.
AMANPOUR: OK. So, I'm going to come back with this to you in a moment with a specific question around Taiwan as you mention. But first, I want to ask
you, Francois Heisbourg, do you believe that it's more of the same and merely the president of France doubling down on what he said, almost from
the beginning of his presidency, that there does need to be more strategic autonomy for Europe?
FRANCOIS HEISBOURG, SENIOR ADVISER FOR EUROPE, INTERNATIONAL INSTITUTE FOR STRATEGIC STUDIES: Right. If that is the case, and I don't think it is,
nobody has actually realized that it is the case. When I see the political and the media bruhaha in Germany and in other European countries, which
have the distinct impression that this is actually quite new language, that we are not playing for the end time, the usual spiel (ph) about strategic
autonomy and so on.
Clearly, Marcon has hit some very real nerves and not only in the states, actually in a rather more vivid way, amongst some of our closer European
partners, not to mention those in the eastern part of Europe, who see Macron's trip in China as being an extension of his attempts to get through
to Putin, except that this time around, he was trying to get through to him via Xi Jinping, who did not, by the way, allow himself to be tempted.
So, clearly, this is perceived as something different. And in politics, we all know that perceptions are also part of the reality.
AMANPOUR: So, you know, you mentioned the criticism, and as we know, as you said from the Bundestag and from elsewhere, for instance, Norbert
Roettgen, who I'm sure you've all read, was very critical. He said that, "Macron has managed to turn his China trip into a P.R. coup for Xi and a
foreign policy disaster for Europe."
So, Former Ambassador Etienne Philippe, do you -- can you see why they would say that? Because none of them were particularly impressed by
President Macron's outreach to President Putin at the beginning of the. They heard what he said, that, I'm going to try to go there and stop this.
But he's had absolutely zero success. What do you think he thinks that he can do so special and different with Xi, whether it's on Ukraine, whether
it's on Taiwan, whatever?
ETIENNE: Well, first, I think that the people who comment what President Marcon said would be well-advised to read the full interview he gave to the
French newspaper, Lizzie Co. (ph), where everything is said, and not only to be satisfied with some excerpts.
And then, I think that we should also take into account the fact that France, under his leadership, has been -- since 2017, one of the countries
who have led the battle inside E.U. to elevate the capacity of the United - - of the European Union, of the European strategics that there were in decisions, which after all, our democracy, it's completely normal. It's
what we call sovereignty, which is absolutely nothing to do -- to act against our alliances.
Just one example, when Lithuania had -- was bullied by China because they had taken some decisions on their relations with Taiwan, we have acted in
solidarity. We have just adopted an (INAUDIBLE) regulation in Brussels, and France has pushed for implementing -- for first adapting and implementing a
lot of new tools to affirm our sovereignty, including against some measures, some decisions taken by China. And in particular, to impose
reciprocity and sovereignty when Europe is facing such decision space by China.
So, it is absolutely not true that we are now in a sort of appeasement center, saying, we are not -- we don't want to be strong. It is exactly the
contrary. We are doing -- we are building up our strengths. And even military, look at the budgets, the different budgets which we are doubling
since the election -- the first election of our president.
AMANPOUR: Can I just ask you both because, obviously, the Taiwan issue has struck the biggest nerve in the United States. So, one of your former
colleagues, Ambassador Etienne, has said -- and this is Gerard Araud, has said that Macron has started an important debate at a time when "the
temptation exists to consolidate us into a western block under American direction, assured to be on the side of the good." And he added, it would
be a mistake to give in to this.
So, when it comes to Taiwan, the West, America thinks Taiwan is on the side of the good and there's sort of, I guess, not so strategic ambiguity is
about defending Taiwan. If some kind of trouble breaks out around Taiwan, initiated by China, do you think France would support the U.S.?
ETIENNE: Well, Christian, I don't know what the U.S. would do anyway. And there is this ambiguity. And I will not answer this question because we
will see when it happens. But the first thing, we must prevent something like that to happen. This is a point. And for this to be avoided and
(INAUDIBLE) is completely right, to agree with him, we must prevent this to be a sort of issues like blocks and we must engage -- including the war in
Ukraine. We didn't speak yet about this. But obviously, China has a role to play.
For the time being, we are really supporting militarily and in all possible fields the Ukrainian resistance against the Russian invasion.
ETIENNE: But, of course, we have to talk with China about this and then to avoid this division into blocks, again, it does not mean that we are
contrary to our alliances. By the way, I was there, still ambassador, during the last visit to the U.S., and I have read the last statements
about U.S., yesterday still, about the relations, extraordinary relations between U.S. and France and praising France in the Indo-Pacific.
AMANPOUR: So, let me ask you now, Francois Heisbourg, particularly on the issue of Ukraine as well and then, I want to play a response from the
United States. So, President Marcon said to President Xi in Beijing, I know I can count on you to bring Russia to its senses. But we also understand
that he didn't get any also from Xi. What do you think in response to what Ambassador Etienne has just said?
HEISBOURG: Yes. Before I answer that question, just the word on Taiwan. The manner in which President Macron spoke about the Chinese and the
American role vis-a-vis attentions concerning Taiwan in the press conferences, in Politico and Liziku (ph), which had, by the way,
interviewing Liziku (ph), I think has been very, very closely read by most serious people in Europe, as in the United States, and it's not good enough
to say that people are currently a bit unhappy. Have read experts.
Now, on Taiwan, President Macron spent rather more time explaining that the Americans had been ramping up tension than doing so vis-a-vis China, when,
of course, it's the exact opposite. China -- I don't approve of everything that the U.S. does in terms of its Taiwan policy, but the U.S. is not
actually conducting threatening military maneuvers around Taiwan, nor has it indicated that it would be ready to use force to reclaim the island, as
And so, the effect of Macron's words on Taiwan in the region, I think, will not have been very greatly appreciated.
I'm sorry, Christiane, but your question actually slipped my mind.
AMANPOUR: That's OK.
HEISBOURG: I realized --
AMANPOUR: No, no, no. That was the question. Now, I'm actually going to play a response from the United -- from those in the U.S. Congress, but
mostly, obviously, Republicans. We know that some have said the President Macron has played directly into the Chinese communist party's agenda, but
Senator Marco Rubio, who you know, is quite powerful in the Senate, the Republican from Florida, he has cast what President Macron has said and
done around China in terms of what it might mean for U.S. support of Ukraine.
Just listened to what he said, and I want to ask you both to react.
(BEGIN VIDEO CLIP)
SEN. MARCO RUBIO (R-FL): We're pretty heavily involved in Ukraine right now. We're spending a lot of our taxpayer money on a European war. And I've
supported that because I think there's in the national interest of the United States to be allies to our allies. But if our allies' position, if
in fact, Marcon speaks for all Europe and their position now is they're not going to pick sides between the U.S. and China over Taiwan, then maybe we
shouldn't be picking sides either. Maybe we should basically say, we're going to focus on Taiwan and the threats that China poses and you guys
handle Ukraine and Europe.
(END VIDEO CLIP)
AMANPOUR: Yikes. Ambassador Etienne, if that's the result, that could be pretty dicey. What do you make of Marco Rubio's association of these two
ETIENNE: Well, first, I don't think this debate in the U.S. has been -- has waited for President Macron's last statements in or back from China, it
is a debate which you have in the United States, as you know. Second, I would question the qualification made by Senator Rubio of the war in
Ukraine as European war. It's the global war. It's a war against democracy. So, it's a war which is a basic interest for the biggest democracy in the
world, which is the most powerful democracy, which is the United States.
And this is a reason why since the very beginning of the invasion, Europe and the U.S. have been working so hard together to defeat this invasion, to
give the Ukrainians all possibilities to win. And we must continue on this way because it's absolutely crucial and it's also a global war because it
affects the whole world. It's not only a violation of all basic principles of the U.N. Charter, it's also -- it has also enormous consequences of the
six security and safety of nuclear plants in Ukraine.
ETIENNE: It has consequences on food, on energy. So, it is a global war. It is of the interest of the U.S. and of Europe to continue to fight for
ETIENNE: And with the Ukrainian.
AMANPOUR: So, on the other issue then, to you, Francois Heisbourg, the U.S. seemed to be asking on the China issue and on strategic autonomy, et
cetera, does Marcon speak for Europe, for the E.U.? Is what he's saying a European feeling or is it just a Marcon statement?
HEISBOURG: First of all, he was speaking as -- Macron, as the French president, and he made that very clear himself. I don't need to expatiate
that. And he certainly was now leaving very much space to Ursula von der Leyen, who is the chairperson of the European Commission who is with co-
traveling, co-visiting China with Marcon. But she didn't get too much of the stage, if I dare say so, because she actually does have a rather tough
She gave a big speech a week ago before the trip, talking about U.S. economy relations between China and the European Union. We did not hear
that from Macron, by the way. So, Europe, as an institution, tends to be on China, currently, somewhat less liberal than President Marcon.
You asked me a question that -- a couple of minutes ago about what Marcon was expecting to get from Xi Jinping concerning Ukraine, and I completely
agree with you Philippe Etienne said about the war there. Well, A, he wanted Xi Jinping indeed to lean Putin, to speak with Zelenskyy, try to put
together a mediation and so on with, apparently, for the time being, absolutely no success.
But the problem here is that Macron spent the years prior to the war, the three years prior to the war, hoping to pull the Russians from the Chinese
embrace, which is certainly did not work.
HEISBOURG: And now, he has been trying to pull China from Russia's embraced by entering into mediation, which Putin's spokesperson immediately
said was not on the cards, that this was not the time for negotiating.
HEISBOURG: And indeed, President Macron had, at the end of this visit, to say that there were no prospects for negotiation.
AMANPOUR: Yes. OK. Well, look, this is a really interesting moment. We're very pleased to have both sides of this story. We've run out of time, but
we will continue to follow it. Ambassador Philippe Etienne and also, Francois Heisbourg, thank you very much, indeed, for joining us.
So, as we mentioned earlier, there are numerous challenges facing the health care system in the United States, with millions of Americans
uninsured and unable to pay for a doctor's visit. Affordable health care is hard to come by
Dr. Ricardo Nuilia works at a Texas hospital where cost is second to care. In his new book, he chronicles the lives of five patients who turned to his
help after facing financial barriers. And he joins Hari Sreenivasan to discuss what America needs to do to fix its health care crisis.
(BEGIN VIDEO CLIP)
HARI SREENIVASAN, CNN INTERNATIONAL CORRESPONDENT: Christiane, thanks. Dr. Ricardo Nuila, thanks so much for joining us.
First, to give our audience a little bit of a background, you're writing this story about a safety net hospital in Houston, Ben Taub. What is a
safety net hospital?
DR. RICARDO NUILA, AUTHOR, "THE PEOPLE'S HOSPITAL": Safety net hospital is a hospital that provides health care even if people don't have health
insurance. The safety net hospital that I'm writing about is Ben Taub hospital. It's part of a system, as health care system in Houston, Texas,
that provides health care for people who can't access health care or can't afford health care, which is becoming more and more in our society.
Again, the safety net hospital is part -- in Houston is a public health care system. This is generated by property taxes to help assure that
everybody has health coverage, health care in the city.
SREENIVASAN: So, give us an idea of the scale, the number or the percentage of people who are coming there for care who don't have
DR. NUILA: Yes. I mean, and Houston is one of the highest uninsured rates in the country, more than 1 million people are uninsured. And Houston,
Texas is one -- is the highest uninsured state in the country, percentage wise. And that's more than 5 million. In the United States, that's 40
million people who are uninsured.
And remember that we pegged health insurance to employment. So, as employment changes, people get laid off, we see more people at the safety
SREENIVASAN: What's the kind of experience that a young doctor can get at a safety net hospital that they might not be able to at -- well, to put it
crudely, a fancier one?
DR. NUILA: Yes. I think it's that contact with people. I think it's the ability to feel the responsibility. That's what kept me in the safety net
hospital is the feeling of responsibility. We're in a crisis of burnout in our profession, and a lot of that has to do with the bureaucracy that comes
with our health care system.
But when that is spread away and you can just deal with what you are in -- you're trained to do, which is to sit and think through problems with
people, I think that that's one of the reasons why people come to the safety net hospital. They also come to see the different pathologies, the
different illnesses that manifests in patients. And that's why lot of students really want to come to safety net hospitals to learn how to train,
it makes them better doctors.
SREENIVASAN: So, let's talk about some of the things that you are more likely to see than perhaps other places. One of the patients that you
describe is a woman named Ebony. And put this in the context of kind of maternal health challenges in the United States or even specifically to
black women and what they face.
DR. NUILA: Right. Ebony had a problem, which is that she was bleeding during her pregnancy and that put her at high risk. She had moved from a
State California where she had Medicaid or her health insurance provided by the state, but she moved to Texas where she was uninsured. And so, when the
bleeding started, she was shuttled between emergency rooms until she found the safety net hospital.
The placenta was blocking the birth canal, which meant that it could not be born without causing a catastrophic bleed. Doctors at that moment offered
her a medical abortion. That would be the best way to ensure that Ebony's life was saved.
SREENIVASAN: So, if she came to you with the same symptoms today in Texas, what would she be facing given how the political landscape has changed?
DR. NUILA: What she would be facing is the -- you know, having to risk her own life for that -- for the -- for that birth, and not even the choice.
That's the thing. Ebony selected to proceed with the pregnancy. But this happens and many women don't want to risk their lives, and that's -- in my
mind, that's their liberty. But in Texas now, it's very confusing for doctors on what advice to give patients like these.
SREENIVASAN: Is it harder now in Texas for a doctor at a hospital or a doctor anywhere to have an honest conversation with a woman about her
health care for fear of being sued by a third-party if the word abortion enters the conversation?
DR. NUILA: Undoubtedly. Now, I'm not an obstetrician. My dad is an obstetrician and my colleagues are obstetricians, and I've spoken with some
of them about this. But one of the things that set safely net hospitals apart, one of the things that we strive for is those -- that transparency
and that conversation and that knowledge that we're going to be trying to help the person make the best decision for their own lives, and that has
changed now because of the abortion laws in Texas.
SREENIVASAN: I mean, you talk about one of the patients that you call Geronimo, and he had needs for a liver transplant, right?
DR. NUILA: Yes.
SREENIVASAN: And tell us a little bit about him. What happened?
DR. NUILA: Well, Geronimo was a gas station attendant who -- he had liver disease that was -- that had gotten to the point where he was very ill and
he made too much -- he qualified for Medicaid. But when he started to get his disability payments, it put him over the -- he wasn't poor enough for
Medicaid. And so, it was taken away from him. That was right at the moment where he needed a liver transplant to survive.
The safety net system does not have transplant capabilities. The infrastructure that's needed to build transplant centers and to have the
personnel so much high investment that, you know, a safety net a system really has to be utilitarian with these funds and say -- and transplants,
it's just not something that it can afford.
So, you know, one of our goals was to try to see if you could qualify for this insurance. Because in America, in order to get a transplant, you do
need insurance, by and large.
SREENIVASAN: There's also an entire demographic that you've probably seen more at this hospital in Houston and perhaps a lot of other hospitals, even
safety net hospitals in other parts of the country, which are undocumented people.
DR. NUILA: Yes.
SREENIVASAN: And you wrote about Roxanna, undocumented women from El Salvador who had complications from a cancer related illness and she needed
amputations. And it's just startling that something like that could well slip through the existing cracks and get to you. Tell us a little bit about
DR. NUILA: Well, it's an example of how broken our system is, that we don't have these standards for dignity for patients. Roxanna came to the
safety net hospital because she had suffered a great complication during a lifesaving surgery. Now, I want to make this clear, the lifesaving surgery
that she had was a moonshine. It was an incredible manifestation of the American health care system. It showed our ambitions. It showed that we
have surgeons capable of doing amazing things. We just can't complete the job and give people chronic care.
So, that when -- in the hospital, when she changed from an emergency patient to a chronic care patient, she was discharged out into her
apartment with gangrenous arms and legs, and there was no plan for how to deal with her. Thankfully, she lived in the city like Houston, where she
could go to the public health care system that is funded by property taxes, from members of the community, and she could get those amputations and the
care that she needed.
SREENIVASAN: So, you're going to stay with conservative values and you've got a legal climate which creates other challenges for you, but you're also
saying that this hospital can be a model for the rest of the country to still have these conservative values and show compassionate care. Explain
DR. NUILA: What's plagued us in America is trying to bring these two big concepts together. And they're represented by different political sides. I
think we want to get costs under control and we want to provide health care for everybody in this country. But because it's so expensive, it's very
difficult to provide for everybody.
What I found in the system where I work in is that these conservative values of cost cutting have come together with the more liberal values of
providing to everybody, regardless of citizenship or insurance status. And I think that one of the reasons that that's happened is because there's
been conversations in order to make this system work. And that's what we really need to look for in designing a health care system, is that
everybody needs to weigh in and we have to look at our similarities.
Seven out of 10 Texans believe that the federal government has a role in providing basic health insurance to everybody in the country. I mean, think
about that. That means that across the political spectrum there is agreement, we just have to focus on that agreement. And what I am really
proud of is that I work in a system where we found those political ways through those political ideologies.
SREENIVASAN: One of the other things that's interesting in the book is how Ben Taub, the hospital, is able to cost about half the national average per
patient. But at the same time, you're the fastest in the country for figuring out whether somebody is having a heart attack or not. So, how can
you keep the costs where they are and still have a level of expertise that the rest of the country hasn't got yet?
DR. NUILA: I think that is the philosophy of quality improvement and making sure that the health care goes to what's needed, OK? There's just
not waste in the system like there is waste in the private health care system, since it's evidence-based medicine and since we are not performing
more health care than is necessary, then we can focus on emergencies like heart attacks, strokes, trauma and build -- break protocols to identify
those and to take care of those in a timely manner.
You know, if you think on the other side, you know, those -- the resources are used for other things that are not as essential and vital for those
things. And I think that that's one of the reasons why we can demonstrate quality while also cutting costs.
SREENIVASAN: Give me an idea of sort of what's the cost difference here on what either you're spending per patient or how do you quantify the level of
efficiency that the safety net hospital has?
DR. NUILA: Yes, that's a great question. And so, there's ways to look at how much Medicare is paying per patient per year. For instance, this year
it was $15,000 per patient per year that Medicare is paying. Private insurance pays less, but only because Medicare is for patients that are 65
and older, who usually utilize health services more.
So, if you take apples and apples, private insurance is actually paying more. But at that our health system, you can look and see what the overall
budget is and how many people are in the system and it's -- more or less, it's less, it's 30 percent of the total costs.
And one of the things that I do in my book is follow a patient and the medical bill that he occurs in our public health care system where there is
that profit motive. One of the patients who had treatment for (INAUDIBLE) cancer that involve x-ray therapy, surgeries, admissions, his total bill
was, what he calls it, less than a pickup truck, $40,000, which is for people who have been in the health care system, they know how little that
is compared to the equivalent in the private system where there's a profit motive.
SREENIVASAN: You know, I also wonder if there is a hesitation on the parts of now doctors, especially in a state like Texas, to come out and speak
like you are. You're talking about the difficult climate about having reproductive health conversations with women. You're talking about sort of
compassionate care for undocumented. You're talking about universalized health care. And I wonder if there is a concern that even having these
conversations, being out front, puts a bull's eye on your back.
DR. NUILA: I feel hopeful in my system because, for instance, I feel that the local government is supportive of this safety net health care system.
But you're right that it -- there is -- it's -- because it is a public health care system, it is subject to the politics of what's going on
I think that, you know, we're also arriving at a crux right here, which is that position burnout is occurring and it's a big problem for the United
States. If you think about how much society pours into doctors studying what they do and performing all the acts, what they do, and that my
colleagues, many of them are leaving the profession early, it just means that we're going to have less doctors with more health care that's needed
for this country.
So, we've hit a point where we need to think about it. We're spending so much money on health care. It's a problem that we've just kicked the can
down the road since 1910s. And now, what it's -- what's happened is that the profession itself is people are leaving it and not wanting to go into
it. And so, that's one of the reasons why I think some people like me are speaking up about it because we're genuinely concerned about that
experience the patients have with the health care system and also, that our colleagues are leaving the profession early.
SREENIVASAN: Now, you are from El Salvador, you came from a family that's three generations of doctors. You also write about your grandmother who
came to you for advice, a medical advice. Tell us what happened.
DR. NUILA: Yes. My grandmother from El Salvador came and -- when I was a younger doctor, she had this problem where she couldn't swallow very well.
And I just went through what the algorithm on how to deal with that, you know. And when the algorithm -- she got a test and it was a normal test, I
just chalked it up to, OK, your symptom -- I don't know what your symptom is due to.
And later, I found out that she got another test when she went back to El Salvador that showed that she had esophageal cancer. And it just showed me
that I had been subject to something that I call algorithm mania, which is that the over reliance on algorithms. I had stopped thinking about the
symptom, stop thinking about the person of my grandmother, the moment that that test came back.
And what I wish that I had done was followed that symptom and said, OK, this test was negative. What -- do you still have symptoms? What else can
we do to figure this out? What ended up happening was is that it led to a spiral, really, where she ended up getting an unnecessary surgery in El
Salvador and she -- I think she suffered greatly from that. I think she could have been diagnosed in a more precise manner. And I still -- it still
weighs on me today.
SREENIVASAN: What do you want people to take away from this book?
DR. NUILA: I want them to take away that there -- we can come together to solve this health care crisis. This health care crisis manifests in so many
ways that we don't think about, that's hidden from us and it affects real people's lives. And -- but we can solve this problem if we just think about
what we aim for, which is we need to decrease costs and we need to give health care access to everybody.
There's strength in numbers. And if we can bind together and think about building a health care system rather than just patching one up, which is
what we've done since the early 1900s, then I think that we can actually solve this problem.
SREENIVASAN: The book is called "The People's Hospital," doctor and author Ricardo Nuila, thanks so much for joining us.
DR. NUILA: Thank you so much for having me.
(END VIDEO CLIP)
AMANPOUR: And right here in the United Kingdom, junior doctors and health care staff are facing many of the same crushing challenges. Indeed, a
strike has started today, a four-day strike by junior doctors.
And finally, tonight, a Lego masterpiece from an iconic artist and prominent Chinese activists. Ai Weiwei's first design exhibition is open
here in London. "Making Sense" is a mix of recent works and commission pieces that reveal our changing values. A reimagination of Monet's iconic
"Water Lilies," for instance, made out of 650,000 Lego bricks is one of the center pieces.
But there is a hole in this piece, and he revealed why when I visited the exhibition ahead of its opening.
(BEGIN VIDEO CLIP)
AMANPOUR: What is this?
AI WEIWEI, CHINESE ACTIVIST AND ARTIST: It only exists on my iPhone. You see the hole?
AMANPOUR: Yes. Yes, I see the whole.
AI WEIWEI: Yes.
AMANPOUR: So, it's a real hole in real-life in China.
AI WEIWEI: That's a real hole. We stayed there for five years inside this hole. So, for me, to view my personal experience into the works I admire
the most among the impressionist.
(END VIDEO CLIP)
AMANPOUR: What he was referring to was the hole, literally, that he and his father were forced to live in during the time -- during the cultural
time there, cultural revolution when his father was arrested. You can catch the full conversation on his latest design exhibition later on this
program, later this week.
That's it for now. Thank you for watching. Good-bye from London